| NPI | 1275902959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12904006-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004982) |
| 363A00000X Physician Assistant (Licence: TX PA10173) | |
| 363A00000X Physician Assistant (Licence: CA 60557) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004982) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2023-06-13 |